Provider Demographics
NPI:1730136888
Name:WELLS, AMY T (DPM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:WELLS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:ME
Mailing Address - Zip Code:04236-0718
Mailing Address - Country:US
Mailing Address - Phone:207-783-7800
Mailing Address - Fax:207-783-7833
Practice Address - Street 1:594 RIVER RD
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:ME
Practice Address - Zip Code:04236-4103
Practice Address - Country:US
Practice Address - Phone:207-783-7800
Practice Address - Fax:207-783-7833
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD192213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
61309OtherBC/BS
ME40708000Medicaid
ME40708000Medicaid
61309OtherBC/BS